Impact of Medicare Age Eligibility on Health Spending among U.S. and Foreign-Born Adults.
Impact of Medicare Age Eligibility on Health Spending among U.S. and Foreign-Born Adults.
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DOI：
10.1111/1475-6773.12402
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发表时间：
2016-06
影响因子：
3.4
通讯作者：
W. Tarraf;G. Jensen;H. González
中科院分区：
文献类型：
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作者：
W. Tarraf;G. Jensen;H. González
目的 研究外国出生和美国出生的成年人中年后期医疗保健支出的差异，以及这些差异在 65 岁之后（医疗保险接近全民）之后如何变化。 DATA 医疗支出小组调查数据（2000-2010 年），涉及 55-75 岁成年人 (n = 46,132)，用于检查年度总支出和特定付款人支出。研究设计我们使用（1）倾向得分匹配来生成具有同等健康需求和医疗保健偏好的准实验样本，（2）广义线性模型来估计支出的群体差异，以及（3）引导方法来获得显着性检验的方差估计。主要发现 在 55-64 岁的成年人中，外国出生的人在医疗保健上的支出减少了 3,314 美元 (p < .001)，即使他们具有相同的健康需求和医疗保健偏好。这种差异主要是由于私人保险支出减少所致。 65 岁之后，总支出的差异消失，但特定付款人支出的差异却没有消失。外国出生的人通过私人保险的支出继续大幅减少，并开始通过医疗保险和医疗补助支出大幅增加。结论 外国出生的中年晚期成年人在医疗保健上的支出明显低于美国出生的成年人。 65 岁以后，随着医疗保险几乎全面覆盖，各组之间总支出的差异消失，尽管付款人的支出差异仍然存在。
OBJECTIVE Examine differences in health care expenditures between foreign-born and U.S.-born adults in late mid-life, and how these differences change after age 65, when Medicare is near-universal. DATA Medical Expenditures Panel Survey data (2000-2010) on adults ages 55-75 years (n = 46,132) to examine annual total and payer-specific expenditures. STUDY DESIGN We use (1) propensity score matching to generate quasi-experimental samples with equivalent health needs and health care preferences, (2) generalized linear modeling to estimate group differences in expenditures, and (3) bootstrapping methods to obtain variance estimates for significance testing. PRINCIPAL FINDINGS Among adults ages 55-64, the foreign-born spend $3,314 (p < .001) less on health care, even when they have equivalent health needs and health care preferences. This difference is due mainly to lower spending through private insurance. After age 65, differences in total spending disappear but not differences in payer-specific spending. The foreign-born continue to spend significantly less through private insurance and begin to spend significantly more through Medicare and Medicaid. CONCLUSION Foreign-born adults in late mid-life spend significantly less on health care than U.S.-born adults. After age 65, with near-universal Medicare coverage, differences in total spending disappear between the groups, although differences in spending by payer persist.